Return to sport following toe phalanx fractures:A systematic review

BACKGROUND Evidence-based guidance on return to sport following toe phalanx fractures is limited.AIM To systemically review all studies recording return to sport following toe phalanx fractures(both acute fractures and stress fractures),and to collate information on return rates to sport(RRS)and mean return times(RTS)to the sport.METHODS A systematic search of PubMed,MEDLINE,EMBASE,CINAHL,Cochrane Library,Physiotherapy Evidence Database,and Google Scholar was performed in December 2022 using the keywords‘Toe’,‘Phalanx’,‘Fracture’,‘injury’,‘athletes’,‘sports’,‘non-operative’,‘conservative’,‘operative’,‘return to sport’.All studies which recorded RRS and RTS following toe phalanx fractures were included.RESULTS Thirteen studies were included:one retrospective cohort study and twelve case series.Seven studies reported on acute fractures.Six studies reported on stress fractures.For the acute fractures(n=156),63 were treated with primary conservative management(PCM),6 with primary surgical management(PSM)(all displaced intra-articular(physeal)fractures of the great toe base of the proximal phalanx),1 with secondary surgical management(SSM)and 87 did not specify treatment modality.For the stress fractures(n=26),23 were treated with PCM,3 with PSM,and 6 with SSM.For acute fractures,RRS with PCM ranged from 0 to 100%,and RTS with PCM ranged from 1.2 to 24 wk.For acute fractures,RRS with PSM were all 100%,and RTS with PSM ranged from 12 to 24 wk.One case of an undisplaced intra-articular(physeal)fracture treated conservatively required conversion to SSM on refracture with a return to sport.For stress fractures,RRS with PCM ranged from 0%to 100%,and RTS with PCM ranged from 5 to 10 wk.For stress fractures,RRS with PSM were all 100%,and RTS with surgical management ranged from 10 to 16 wk.Six cases of conservatively-managed stress fractures required conversion to SSM.Two of these cases were associated with a prolonged delay to diagnosis(1 year,2 years)and four cases with an underlying deformity[hallux valgus(n=3),claw toe(n=1)].All six cases returned to the sport after SSM.CONCLUSION The majority of sport-related toe phalanx fractures(acute and stress)are managed conservatively with overall satisfactory RRS and RTS.For acute fractures,surgical management is indicated for displaced,intra-articular(physeal)fractures,which offers satisfactory RRS and RTS.For stress fractures,surgical management is indicated for cases with delayed diagnosis and established nonunion at presentation,or with significant underlying deformity:both can expect satisfactory RRS and RTS.

Do age-associated changes of voltage-gated sodium channel isoforms expressed in the mammalian heart predispose the elderly to atrial fibrillation?

Atrial fibrillation(AF)is the most common cardiac arrhythmia worldwide.The prevalence of the disease increases with age,strongly implying an age-related process underlying the pathology.At a time when people are living longer than ever before,an exponential increase in disease prevalence is predicted worldwide.Hence unraveling the underlying mechanics of the disease is paramount for the development of innovative treatment and prevention strategies.The role of voltage-gated sodium channels is fundamental in cardiac electrophysiology and may provide novel insights into the arrhythmogenesis of AF.Na_v1.5 is the predominant cardiac isoform,responsible for the action potential upstroke.Recent studies have demonstrated that Na_v1.8(an isoform predominantly expressed within the peripheral nervous system)is responsible for cellular arrhythmogenesis through the enhancement of pro-arrhythmogenic currents.Animal studies have shown a decline in Na_v1.5 leading to a diminished action potential upstroke during phase 0.Furthermore,the study of human tissue demonstrates an inverse expression of sodium channel isoforms;reduction of Na_v1.5 and increase of Na_v1.8 in both heart failure and ventricular hypertrophy.This strongly suggests that the expression of voltage-gated sodium channels play a crucial role in the development of arrhythmias in the diseased heart.Targeting aberrant sodium currents has led to novel therapeutic approaches in tackling AF and continues to be an area of emerging research.This review will explore how voltage-gated sodium channels may predispose the elderly heart to AF through the examination of laboratory and clinical based evidence.

Assessment of the Contributions of Private Provider Engagement in Tuberculosis Case Finding and Notification in South West Nigeria

Introduction: Tuberculosis is one of the leading causes of mortalities attributable to an infectious disease. In a private sector-driven health system such as Nigeria, the private health providers are very important stakeholders in tuberculosis diagnosis and management. Unfortunately, there are few data on the level of contribution of these private health providers to the case finding and notification of tuberculosis in Nigeria. Consequently, this study assessed the contribution of the private providers to the diagnosis and treatment of tuberculosis under the Global Fund Private Public Mix New Funding Model (2nd phase) grant (GF PPM NFM2) in the four implementing states of south west Nigeria. Materials and Methods: This is a retrospective, cross-sectional analysis of the NFM2 programme implementation data collected between January 1, 2019 and December 31, 2020. Data was extracted from the routine registers such as the presumptive TB registers;treatment register of the private health facilities engaged for PPM activities between 2019 and 2020. The data was entered and analyzed using Microsoft excel package. The variables were summarized using appropriate charts and table. Results: Concerning the percentage contribution of the Global Fund Private Public Mix (GF PPM) grant to the total state TB case notification, majority of the implementing states show some progressive rise in the contribution of GF PPM to State TB case notification as the grant implementation progressed. Furthermore, at the initial period of the grant implementation, the health facilities seemed to have generated majority of the cases. However, as the grant implementation progressed, the PPMVs were responsible for the diagnosis of majority of the cases. Conclusion: As the grant progressed, there was a progressive increase in the number of presumptive TB cases as well as in the number of notified cases of tuberculosis attributable to private provider engagement.

The Tidal Stream Power Curve: A Case Study

It is important to understand the relationship between the ambient ebb and flood currents and the electricity generated by tidal stream power generators to minimise investment risk and to optimise power generation for distribution purposes. Such analyses no longer rely on average descriptions of the flow field or on single values for the device efficiency. In the present paper, we demonstrate a new method involving the integration of synthesised long termflow vectors with logistic descriptions of the device power curves. New experiments are then described with the Neptune Proteus vertical axis tidal stream power generator involving tow tests at speeds to 1.5 ms–1 in William Wright Dock on the Humber. The results are used to derive appropriate coefficients in the logisticcurve and to estimate the device’s annual electrical output.

REVIEW OF HIGH LEVEL FAULT MODELING APPROACHES FOR MIXED-SIGNAL SYSTEMS

In the modern analogue design, Transistor Level Fault Simulation (TLFS) plays the im-portant part since every fault in the whole circuit has to be simulated at that level. Unfortunately, it is a very CPU intensive task even though it maintains the high accuracy. Therefore, High Level Fault Modeling (HLFM) and High Level Fault Simulation (HLFS) are required in order to alleviate the efforts of simulation. In this paper, different HLFM approaches are reviewed at the device level during last two decades. We clarify their domains of application and evaluate their strengths and current limitations. We also analyze causes of faults and introduce various test approaches.

The Use of Sputum Dashboard and Dispatch Riders in Mitigating Delay in Sputum Samples’ Processing—Evidence from an Intervention in Lagos State, Nigeria

The act of referring TB presumptive individuals after verbal screening to another health facility/diagnostic centres for testing often results in large loss to follow-up, owing to the many barriers people face in accessing care. The transportation of sputum samples is an efficient method of increasing access to tuberculosis (TB) diagnostics in areas where testing is not currently available. One of the major reasons for the low yield of TB cases in the field was delay in sputum sample transportation to diagnostic laboratories among other factors. Damien Foundation Belgium, carried out a unique sputum riders initiatives in 20 LGAs of Lagos state between Q3-2019 and Q4-2020. A total of 25 sputum dispatch riders across the 20 LGAs in the State who are monitored routinely on an electronic dashboard were engaged for sputum logistics. Therefore, this report highlights how the initiatives have contributed to increased TB case notification in a densely populated metropolitan city in Nigeria. Overall, 48,265 units of sputum samples were transported to the laboratory from the facilities 99.9% of results which were received from the laboratory by the dispatch riders. The contribution of sputum riders to the overall TB case detection by the project progressively increased from 9% when the intervention began to 57% as at Q4 2020. The transportation of sputum samples by motorcycle dispatch riders is an efficient method of increasing access to TB diagnostic services in communities where testing is not currently available.

Quantum Information Medicine: Bit as It—The Future Direction of Medical Science: Antimicrobial and Other Potential Nontoxic Treatments

Experimental evidence has accumulated to suggest that biologically efficacious informational effects can be derived mimicking active compounds solely through electromagnetic distribution upon aqueous systems affecting biological systems. Empirically rigorous demonstrations of antimicrobial agent associated electromagnetic informational inhibition of MRSA, Entamoeba histolytica, Trichomonas vaginalis, Candida albicans and a host of other important and various reported effects have been evidenced, such as the electro-informational transfer of retinoic acid influencing human neuroblastoma cells and stem teratocarcinoma cells. Cell proliferation and differentiation effects from informationally affected fields interactive with aqueous systems are measured via microscopy, statistical analysis, reverse transcription polymerase chain reaction and other techniques. Information associated with chemical compounds affects biological aqueous systems, sans direct systemic exposure to the source molecule. This is a quantum effect, based on the interactivity between electromagnetic fields, and aqueous ordered coherence domains. The encoding of aqueous systems and tissue by photonic transfer and instantiation of information rather than via direct exposure to potentially toxic drugs and physical substances holds clear promise of creating inexpensive non-toxic medical treatments.

Simulation of the deformable lateral boundaries in biaxial test using DEM

Applying the discrete element method(DEM)in soil mechanics can provide abundant information at the particle-scale and facilitates illustration of the macro-mechanical behaviour of soils based on the inter-particle mechanisms.The triaxial test is one of the most common laboratory methods to study the macro-mechanical behaviour of particulate materials such as soil.However,many problems in geotechnical design can be assumed and simplified as a plane strain phenomenon.Therefore a biaxial test can be conducted to reproduce the macro-mechanical behaviour of soil,where the sample is enclosed by two horizontal rigid platens and a vertical latex membrane,which is a deformable continuous element and allows the enclosed specimen to deform freely while maintaining confining stress during loading.This paper presents an algorithm to represent physical and mechanical characteristics of latex membrane in the 2D DEM simulation of biaxial test using the PFC^(2D) code.To investigate the impact of the lateral boundary conditions on the micro-macro mechanical behaviours of soil samples,two sets of DEM biaxial tests are conducted,i.e.with rigid and deformable lateral boundary conditions.The DEM modeling results indicate that the lateral boundary conditions have a significant effect on the micro-scale fabric properties,thickness and inclination of the shear band.The comparison between these two simulations also demonstrates that the lateral boundary conditions play a major role in the peak and post-peak stress-strain behaviours as well as the dilation and critical state behaviours of granular soils.